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| CASE REPORT |
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| Year : 2023 | Volume
: 6
| Issue : 1 | Page : 5-8 |
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Management of hypertrophic rhinitis by application of Kadali kshara: An observation
A Anjali, K Sivabalaji, BN Ashwini
Department of Shalakya Tantra, Amrita School of Ayurveda, Kollam, Kerala, India
| Date of Submission | 20-Apr-2022 |
| Date of Acceptance | 14-Feb-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Dr. A Anjali
Department of Shalakya Tantra, Amrita School of Ayurveda, Vallikavu, Kollam - 690 525, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jacr.jacr_32_22
Nasal obstruction is a predominant symptom in hypertrophied inferior turbinate. It can be understood as Nasanaha (~nasal obstruction) in Ayurveda. Even though there are many conditions of the nose causing nasal blockage; inferior turbinate hypertrophy which is a cardinal feature in hypertrophic rhinitis is one of the most common causes of anatomical nasal obstruction, the others being internal nasal valve stenosis and septal deviation. The turbinate hypertrophy in this condition can be managed medically using nasal decongestants and corticosteroids and it can be also managed surgically. Continuous use of nasal decongestants can cause rebound congestion. Surgical management also has limitations such as synechiae formation and postoperative bleeding. Kshara pratisarana (~external application of alkali), which is one among the types of parasurgical procedures explained in Ayurveda, can be used effectively in this condition. Moreover, nasal obstruction is one of the most common symptoms presented to an otorhinolaryngologist and it badly affects the quality of life of the patient. The present case report is a case of a 24-year-old female who was unable to sleep properly due to severe nasal obstruction and chronic rhinitis along with hypertrophy of both inferior turbinates. This also affected her studies badly. She also complains of thick nasal discharge along with obstruction. The patient had the complaints for two years but the symptoms became more severe during the past six months. On anterior rhinoscopic examination using Thudicum's nasal speculum, the presence of bilateral inferior turbinate hypertrophy was observed. The patient was treated with Pratisarana of Kadali kshara (~alkali of Musa paradisiaca Linn.) along with Sigrusimhyadi taila nasya. The treatment was effective in the present case with no recurrence during a follow-up period of 30 days. This case report revealed that nasal obstruction, which is a common problem seen nowadays can be managed effectively using Ayurvedic intervention.
Keywords: Hypertrophic rhinitis, Kadali kshara, Nasal obstruction, Nasanaha, Nasya
How to cite this article:
Anjali A, Sivabalaji K, Ashwini B N. Management of hypertrophic rhinitis by application of Kadali kshara: An observation. J Ayurveda Case Rep 2023;6:5-8 |
How to cite this URL:
Anjali A, Sivabalaji K, Ashwini B N. Management of hypertrophic rhinitis by application of Kadali kshara: An observation. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:5-8. Available from: http://www.ayucare.org/text.asp?2023/6/1/5/372247 |
| Introduction | |  |
Chronic rhinitis symptoms are among the most common problems presenting to physicians. Hypertrophic rhinitis is a chronic condition, in which there will be irreversible changes in the form of hypertrophy of the mucous membrane and also the submucous layer of the nasal cavity, periosteum, and bone, which is more marked on the inferior turbinate.[1] Among all the anatomical reasons for nasal obstruction causing a nasal blockage, inferior turbinate hypertrophy accounts for the majority of the cases.[2] The prevalence of nonallergic rhinitis has not been studied definitively but it appears to be very common.[3] Nasal obstruction impairs daily and social activities, thereby affecting the quality of life of the patient. It affects the overall well-being of the individual. In Ayurveda, hypertrophic rhinitis can be understood as Nasanaha (~nasal obstruction) and can be treated using Nasya karma (~errhine therapy). Shirovirechana (~medication through the nose for cleansing) with Sigrusimhyadi taila is given here to prevent the root cause of hypertrophied inferior turbinate. Once the root cause is addressed, then the inferior turbinate hypertrophy is treated using a minimally invasive and parasurgical procedure called Ksharakarma. Here, Kadali kshara (~alkali of Musa paradisiaca Linn.) is used for Pratisarana (~local external application) over the hypertrophied inferior turbinate.
| Patient Information | | |
A 24-year-old female patient presented with complaints of nasal obstruction which is on and off in nature and nasal discharge. The patient had the complaints for two years but the symptoms became more severe during the past six months along with difficulty in sleeping due to nasal obstruction. This problem badly affected her studies. The patient does not have any family history related to the condition. The condition usually aggravates on exposure to cold and during cold climates and also by intake of cold drinks and foods. The patient had undergone several medical treatments including the use of nasal decongestants and intranasal corticosteroids under the consultation of an ear, nose, and throat specialist. However, the condition recurs after the withdrawal of medicines.
| Clinical Findings | | |
The size and shape of the nose were normal. There were no swellings or deformities externally. No scars or skin changes were noted during the external examination of the nose. Thudicum's nasal speculum was used to do the anterior rhinoscopic examination of the patient. The nares appeared normal. The nasal cavity appeared to be edematous and inflamed. There were no potential bleeding sites. No foreign bodies were present in the nasal cavity. There was no septal deviation, septal perforation, and the presence of the septal spur. Bilateral inferior turbinate hypertrophy along with congested nasal mucosa and thick nasal discharge was observed during the examination. The nasal polyp was absent.
| Timeline | | |
The detailed timeline with therapeutic intervention is given in [Table 1].
| Diagnostic Assessment | | |
Ayurvedic assessment of the patient was done using Ashtavidha pareeksha (~eight-fold examination of the patient) and Dasavidha pareeksha (~ten-fold examination of the patient) which is given in [Table 2] and [Table 3]. The condition was diagnosed as hypertrophic rhinitis based on the complaints presented by the patient and by the presence of hypertrophy of the inferior turbinate bilaterally using anterior rhinoscopy. Nasal obstruction, nasal discharge, nasal congestion, headache, and inferior turbinate hypertrophy were the diagnostic criteria used here.[1] Nasal obstruction and congestion were assessed using Nasal Obstruction Symptom Evaluation (NOSE) score.[4] Nasal discharge was assessed using Lund-Kennedy endoscopic grading.[5] Hypertrophy of the inferior turbinate was diagnosed by anterior rhinoscopic examination using Thudicum's nasal speculum and was assessed by endoscopic grading.[6]
| Therapeutic Intervention | | |
Sigrusimhyadi taila mentioned in Ashtanga hridayam was used for Marshanasya (~high dose medication through nasal route) in this case after Mukhabhyanga (~therapeutic oil massage for face) with Asanavilwadi taila followed by steam inhalation.[7] On the 2nd, 5th, and 8th day of treatment, Kshara pratisarana (~external application of alkali) was done on the hypertrophied inferior turbinate with Kadali kshara, followed by mopping with lemon juice. Here, Kadali is used as a drug for Kshara preparation as it is one of the drugs mentioned in Sushruta Samhita for Pratisaraneeya kshara preparation [Table 1].
| Follow-up and Outcome | | |
The follow-up was done on the 15th day and on the 30th day after the treatment and the results revealed an improvement in the NOSE score of the patient from 100 to 20. The patient was evaluated for six months after the follow-up period, and the effect of treatment was found to be persisting subjectively. The nasal discharge which was thick and purulent became clear and thin. Moreover, the patient was able to sleep properly during the follow-up period, which was her main concern. There was a marked improvement in the daily and social activities of the patient with overall well-being. The size of the hypertrophied inferior turbinate reduced from Grade 3 (inferior turbinate occupying 50%–75% of nasal cavity) to Grade 2 (inferior turbinate occupying 25%–50% of nasal cavity) after seven days of Nasya karma and three sittings of Kshara pratisarana.
| Discussion | | |
In this particular case, initially, Nasya was given to remove the root cause of obstruction then followed by Kshara pratisarana. In the present case study, there was a marked improvement in the nasal obstruction of the patient which was her main concern on the first visit and she was able to sleep comfortably after the treatment and during the entire follow-up period of 30 days. Kshara (~alkali) due to its Chedana (~excision), Bhedana (~therapeutic incision), and Lekhana (~therapeutic scrapping) properties helped to reduce the size of the hypertrophied inferior turbinate, thereby reducing the anatomical obstruction in the pathway. In the present case, Kadali kshara was used as it is one of the drugs mentioned in Kshara pakavidhi (~preparation of therapeutic alkali).[8] Besides Kadali is a drug which is available in all parts of the country during all seasons having Madhura rasa (~sweet taste), Sheetavirya (~cold potency), Guru snigdhaguna (~heavy, unctuous qualities), and Madhura vipaka (~sweet in bio transformed rasa), so it would be less irritant and cause minimal pain and burning sensation which is an added benefit in a highly sensitive area such as nasal mucosa. Shirovirechana (~medication through the nose for cleansing) with Sigrusimhyadi taila here addressed the chronic rhinitis which was the root cause of nasal obstruction in this patient. The Teekshna (~high potency) and Kaphahara nature of Sigru (Moringa oleifera Lam.), Simhi (Solanum indicum Linn.), Nikumbha (Baliospermum montanum [Willd.] Müll. Arg.), Vyosha (Zingiber officinale Roscoe., Piper nigrum Linn., Piper longum Linn.), Saindhava (sodium chloride), and Surasa (Ocimum sanctum Linn.) help in this condition.[7] With seven days of Nasyakarma and three sittings of Kshara pratisarana, the patient was having relief in the nasal obstruction, nasal discharge, nasal congestion, and headache.
| Conclusion | | |
Pratisaraniya kshara is one among the types of Kshara karma which can be used effectively in any growth which is unhealthy. In this present case report, the Kadali kshara application was done locally after Marshanasya for the assessment of its efficacy. No adverse event was reported by the patient during the treatment and also during the follow-up period. From the present case study, it can be concluded that it was highly effective in the symptomatic management of hypertrophic rhinitis. Due to its cost-effectiveness and curative results, Kshara karma can be taken as one of the treatment options. Hence, Kadali kshara is effective in the management of hypertrophic rhinitis.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient has given her consent for reporting the case along with the images and other clinical information in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ivanovich K, Bondareva G, Thao N. Allergic rhinitis complicated by hypertrophy of the mucous membrane of nasal turbinates in patients of Northern Vietnam. BMRAT 2020;7:3813-8.  |
| 2. | Clark DW, Del Signore AG, Raithatha R, Senior BA. Nasal airway obstruction: Prevalence and anatomic contributors. Ear Nose Throat J 2018;97:173-6. |
| 3. | Settipane RA, Charnock DR. Epidemiology of rhinitis: Allergic and nonallergic. Clin Allergy Immunol 2007;19:23-34. |
| 4. | Gerecci D, Casanueva FJ, Mace JC, Annen A, Barrett DM, Kim MM, et al. Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty. Laryngoscope 2019;129:841-6. |
| 5. | Camacho M, Zaghi S, Certal V, Abdullatif J, Modi R, Sridhara S, et al. Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales. Plast Surg Int. 2016;2016:6945297. doi: 10.1155/2016/6945297. Epub 2016 May 16. PMID: 27293885; PMCID: PMC4884800. |
| 6. | Rao SU, Basavaraj P, Yempalle SB, Ramachandra AD. A prospective study of different methods of inferior turbinate reduction. J Clin Diagn Res 2017;11:C01-3. |
| 7. | Shastri HS, editor. Commentary by Arundutta and Hemadri on Astanga Hridayam of Vagbhata, Uttara Sthana; Ch. 20, Ver. 22. Varanasi: Chowkhambha Surbharati Prakashan; 2009. p. 845. |
| 8. | Shastri A. 'Ayurveda TatvaSandipika', Sutrasthana 11/3. In: Sushruta; Sushruta Samhita. Varanasi: Chawkhamba Sanskrit Sansthan; 2001. p. 34. |
[Table 1], [Table 2], [Table 3]
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